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Gloria Posted Thu 08th of December, 2011 21:41:59 PM

Would shortening of the stylohyoid process for Eagle's syndrome be best coded as 42999, unlisted procedure pharynx, or as you suggest 21499, unlisted musculoskelatal procedure, and why? Although reduction of the calcified ligament is musculoskelatal, the procedure is done in the pharynx. In comparing a similar procedure in work value is there something in the Care of Fractures/Dislocations of the Cranial and Facial Bones that would be comparable? A comparable procedure in anatomy and work value seems to be 42900.

SuperCoder Answered Fri 09th of December, 2011 04:46:19 AM

Eagle syndrome is a rare condition where an elongated styloid process (more than 30mm) is in conflict with the adjacent anatomical structures. Two forms of eagle syndrome exists: The classic form and the vascular one. Classis is related to sore throat, dysphagia, facial and neck pain etc. whereas the patient with vascular form of Eagle syndrome, elongated styloid process is in contact with extracranial internal carotid artery. This can cause compression of carotid artery whcih comes as a result of TIA or stroke.
So, as reduction of the calcified ligament is musculoskelatal and "styloid process" is usually serving as points of attachment of muscles, it should go to 21499 as per my view and even though procedure is performed on pharynx, but work is done for shortening of styloid process. You could compare (Care of Fractures/Dislocations of the Cranial and Facial Bones) as 21356, 21360, 21365, or 21366 based on RVUs. Among four Pxs, 21366 has highest RVU and it includes obtaining bone graft. If internal fixation is done with multiple surgical approaches, you could compare with 21365.

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